单次亚麻醉剂量艾司氯胺酮对全身麻醉下结直肠癌根治术患者术后早期情绪反应及恢复情况的影响

Effect of a single subanesthetic dose of esmketamine on early postoperative emotional response and recovery in patients undergoing radical resection of colorectal cancer under general anesthesia

目的研究单次亚麻醉剂量艾司氯胺酮对全身麻醉下结直肠癌根治术患者术后早期情绪反应及恢复情况的影响。方法采用回顾性分析,选取2022年10月至2023年4月南京大学医学院附属鼓楼医院收治的120例全身麻醉下结直肠癌根治术患者为观察对象,按照麻醉方式不同分为研究组(n=60)与对照组(n=60)。研究组全身麻醉诱导之前给予0.3 mg/kg体重艾司氯胺酮一次性静脉推注,对照组正常麻醉;两组患者全身麻醉诱导、手术过程中麻醉维持、手术完成之后静脉镇痛药物及方式一致。比较两组患者手术前后焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分与术后(24、48 h)恢复质量评分量表(QOR40)评分、术后(1、3、6、18、24 h)视觉模拟评分法(VAS)评分、术后(24、48 h)改良警觉/镇静评分(MOAA/S)量表评分、术后苏醒时间、术后首次排气时间、术后下床时间及术后不良反应发生率。结果术后48 h,研究组患者SAS、SDS评分均明显低于术前,差异均有统计学意义(P<0.05);对照组手术前后SAS、SDS评分比较,差异均无统计学意义(P>0.05);研究组术后48 h SAS、SDS评分分别为(44.21±4.58)、(41.26±5.09)分,均低于对照组[(52.84±5.69)、(51.03±6.48)分],差异均有统计学意义(P<0.05)。研究组患者术后24、48 h QOR40评分分别为(142.51±4.86)、(150.84±5.73)分,均高于对照组[(134.06±5.17)、(142.49±5.52)分],差异均有统计学意义(P<0.05)。研究组患者术后1、3、6、18、24 h VAS评分分别为(2.49±0.74)、(2.27±0.68)、(2.11±0.64)、(1.97±0.63)、(1.86±0.65)分,均低于对照组[(2.97±0.81)、(2.71±0.75)、(2.58±0.69)、(2.47±0.65)、(2.33±0.67)分],差异均有统计学意义(P<0.05)。研究组患者术后24、48 h MOAA/S评分分别为(141.42±14.51)、(150.28±14.86)分,均低于对照组[(133.19±13.18)、(142.22±13.47)分],差异均有统计学意义(P<0.05)。研究组患者术后首次排气、下床时间分别为(39.01±4.73)、(33.31±4.57)h,均明显短于对照组[(43.86±5.25)、(37.65±5.19)h],差异均有统计学意义(P<0.05);两组患者术后苏醒时间比较,差异无统计学意义(P>0.05)。两组患者术后总不良反应发生率比较,差异无统计学意义(P>0.05)。结论单次亚麻醉剂量艾司氯胺酮用于全身麻醉下结直肠癌根治术麻醉可有效缓解患者情绪反应,提升术后早期镇痛、镇静效果,缓解疼痛程度,提高术后恢复质量及速度,且不良反应少。

Objective To study the effect of a single subanesthetic dose of esmketamine on early postoperative emotional response and recovery in patients undergoing radical resection of colorectal cancer under general anesthesia.Methods The research method was retrospective analysis.A total of 120 patients with colorectal cancer undergoing radical surgery under general anesthesia admitted to Nanjing Drum Trower Hospital from October 2022 to April 2023 were selected as observation subjects.They were divided into the study group(n=60)and the control group(n=60)according to different anesthesia methods.After general anesthesia induction(5 minutes before skin incision),the study group was given a one-time intravenous injection of 0.3 mg/kg esmketamine.General anesthesia induction,anesthesia maintenance during operation and patient-controlled intravenous analgesia after operation were the same in both groups.The scores of self-rating anxiety scale(SAS),self-rating depression scale(SDS)and postoperative recovery quality scale(QOR40)at 24 and 48 h after operation,visual analogue scale(VAS)at 1,3,6,18 and 24 h after operation,improved vigilance/sedation scale(MOAA/S)at 24 and 48 h after operation,postoperative recovery time,first postoperative exhaust time,postoperative bedtime,and incidence of postoperative adverse reactions of the two groups were compared.Results The SAS and SDS scores of the study group at 48 hours after operation were significantly lower than those before surgery,and the differences were statistically significant(P<0.05);there was no statistically significant difference in SAS and SDS scores before and at 48 hours after operation in the control group(P>0.05).The SAS and SDS scores of the study group at 48 hours after operation were(44.21±4.58)and(41.26±5.09)points,respectively,which were lower than those of the control group[(52.84±5.69)and(51.03±6.48)points],and the differences were statistically significant(P<0.05).The QOR40 scores of the study group patients at 24 and 48 hours after operation were(142.51±4.86)and(150.84±5.73)points,respectively,which were higher than those of the control group[(134.06±5.17)and(142.49±5.52)points],and the differences were statistically significant(P<0.05).The VAS scores of the study group at 1,3,6,18,and 24 hours after operation were(2.49±0.74),(2.27±0.68),(2.11±0.64),(1.97±0.63),and(1.86±0.65)points,respectively,which were lower than those of the control group[(2.97±0.81),(2.71±0.75),(2.58±0.69),(2.47±0.65),and(2.33±0.67)points],and the differences were statistically significant(P<0.05).The MOAA/S scores of the study group at 24 h and 48 h after operation were(141.42±14.51)and(150.28±14.86)points,respectively,which were significantly lower than those of the control group[(133.19±13.18)and(142.22±13.47)points],and the differences were statistically significant(P<0.05).The time of first exhaust and getting out of bed in the study group were(39.01±4.73)and(33.31±4.57)hours,respectively,which were significantly shorter than those in the control group[(43.86±5.25)and(37.65±5.19)hours],and the differences were statistically significant(P<0.05);there was no statistically significant difference in postoperative recovery time between the two groups of patients(P>0.05).There was no statistically significant difference in the overall incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusion A single subanesthetic dose of esmketamine for radical resection of colorectal cancer under general anesthesia can effectively relieve the emotional response of patients,improve the early postoperative analgesia and sedation effect,relieve the degree of pain,and improve the quality and speed of postoperative recovery,with fewer adverse reactions.